As we approach the last Saturday of June in 2020, we also head towards an international day to create positive awareness, promote education and unite those with this condition.
The Scoliosis Association United Kingdom (SAUK) launched this day in 2013 to further develop worldwide understanding and promotion of scoliosis; to bring together and network those suffering with it too.
What is scoliosis?
Scoliosis is a condition involving abnormal lateral (sideways) curvature of the spine (Veritas, 2020).
A number of different factors can influence whether scoliosis develops in an individual – it can be developmental, congenital (present from birth), from a degenerative problem or in most cases, idiopathic (no known cause).
Scoliosis affects either the thoracic (midback) or thoracolumbar (lower midback to lower back) regions of the spinal column. There has been a familial link (genetic) noted with this condition and it can run in families. Specific genes are yet to be identified. Scoliosis can affect females more than males.
Idiopathic scoliosis is further specified in diagnosis by the age of onset.
- Infantile scoliosis develops from birth to 3 years of age
- Juvenile scoliosis develops between ages 4-9
- Adolescent scoliosis develops between ages 10-18
It often begins to appear in adolescence (80%), with increasing evidence of the following:
- Postural changes such as lack of symmetry between shoulder girdle height
- Scapular “winging” (lifting of the lower tip of the scapular such as to appear like a wing) or lack of symmetry in height
- Bending to the side when trying to stand upright
- Pronounced appearance of one side of the rib cage when bending forward
- Development of musculoskeletal pain (from torso instability and muscular tightness/spasm as a result of spinal changes) (Veritas, 2020); (Kalichman & Lotan, 2019)
It can be so prevalent in adolescence, due to the fact that kids grow so rapidly during this period of their life. For this reason, when evident at this point in life – it needs to be monitored closely for progression as the child continues to grow. Such rapid growth can produce significant changes in a short space of time that can be detrimental to their spinal health in years to come.
Additional types of specification include:
Dextroscoliosis is fairly common (where there is a reverse C-shape appearance with curvature of the spine to the right). This can occur in the thoracic or thoracolumbar regions.
Right thoracic, thoracolumbar and lumbar curves are common types falling under the dextroscoliosis specification.
Levoscoliosisis a C-shaped curvature of the spine to the left in the thoracic (rare) or thoracolumbar regions.
With the forms of dextroscoliosis, double major curve type scoliosis is another common type that is – of all four – the most pronounced.
It typically involves a right thoracic curve at the top, and a left lumbar curve below – creating the reputable S-bend look that is often stereotyped with scoliosis of the spine.
How is scoliosis diagnosed?
Using XRAY images, any sideways curvature of the spine of at least 10°is diagnosed as scoliosis. It needs to be noted that small changes in the spine curve such as this, would not be easily visibly detected. They would likely be found at this small increment, by incidental spinal imaging in most cases. This would likely be conducted for another reason – such as suspected spinal fracture from a traumatic event such as a car accident or fall where lower back or thoracic pain is present.
Curvature of the spine closer to 20°is more commonly detected, as it is evident by the child’s posture at this point. Monitoring is very necessary at this point (Kalichman & Lotan, 2019).
Treatment and management of scoliosis
Regular XRAY imaging every 4-6 months is necessary once scoliosis is detected. If not yet 25°, is will be monitored like this periodically and determined if progressing or remaining the same.
In some instances, when past 20°(as often at this point, scoliosis tends to progress mostly) a back brace is recommended for the adolescent to use until skeletal maturity. This has the potential to prevent progression of the curvature and hopefully make surgical intervention unnecessary. Of those diagnosed, only 10% have curves that progress to require surgery (Bickley, 2016).
Once mature, surgical options are recommended if progression is unchanged. Presently, a posterior spinal fusion is one of the most common approaches used.
Osteopathic treatment can provide relief of increased muscle tone, pain and promote increased range of motion in areas of restriction created by scoliotic changes (Kalichman & Lotan, 2019). In addition to osteopathy, other areas of manual therapy that include sound understanding of the spine, such as chiropractic and myotherapy, can provide relief to those dealing with symptoms associated with scoliosis.
What should I do if scoliosis may be present in my child or family member?
If some of the symptoms or signs previously mentioned are evident to you in your child or a person you know, it can be helpful to recommend visit to a qualified practitioner for further investigation.
General practitioners, as well as Osteopath and Chiropractors, can perform orthopaedic assessments and organise referrals for necessary imaging to diagnose scoliosis. Once results from a thorough orthopaedic examination and medical imaging (if deemed necessary) are obtained, a working clinical diagnosis can be provided to the patient. Manual therapy can be provided to aim to provide relief to the patient, if they are experiencing restriction or pain.
Appropriate referral to an orthopaedic surgeon can be organised by general practitioners, in the event that the patient is approaching skeletal maturity (approximately 18 years of age); otherwise the scoliosis will likely be monitored if below 20°in curvature (Kalichman & Lotan, 2019); (Veritas, 2020).
Should you require any further information or would like to speak to an Osteopath, don’t hesitate to contact your Osteopath or general practitioner.
At Hands On Osteopathy, we welcome questions!
Lenore is available to discuss scoliosis with you via email (info@handsonosteopathy.com) or mobile (0421 170 791).
Take care everyone and stay safe,
Lenore Dyson
References
Bickley, L. Bates’ Guide to Physical Examination and History Taking(12thEd) Wolters-Kluwer, 2016
Kalichman, L; Lotan, S. Manual therapy treatment for adolescent idiopathic scoliosis. Journal of Bodywork and Movement Therapies. 23 (1) (2019) 189-193
Scoliosis definition https://www.spine-health.com/glossary/scoliosis (1999-2020) (accessed 20/6/20)
Scoliosis: symptoms, treatment and surgery https://www.spine-health.com/conditions/scoliosis/scoliosis-what-you-need-know
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